Which treatments are most effective for common tendinopathies? A systematic review and network meta-analysis protocol (original) (raw)
Related papers
2021
Given the extensive use and initial support for exercise therapies across the tendinopathy literature, and the lack of previous attempts to quantitatively synthesise large amounts of effectiveness data across multiple tendinopathy types, the following systematic review and meta-analysis will be conducted. Network structures will be used to compare exercise treatments and treatment classes in attempts to identify a treatment hierarchy. Additionally, the large amount of data synthesised will be used to explore relevant factors that may explain statistical heterogeneity.
BMJ Open Sport & Exercise Medicine
ObjectiveTo quantify and describe effect size distributions from exercise therapies across a range of tendinopathies and outcome domains to inform future research and clinical practice through conducting a systematic review with meta-analysis.DesignSystematic review with meta-analysis exploring moderating effects and context-specific small, medium and large thresholds.Eligibility criteriaRandomised and quasi-randomised controlled trials involving any persons with a diagnosis of rotator cuff, lateral elbow, patellar, Achilles or gluteal tendinopathy of any severity or duration.MethodsCommon databases, six trial registries and six grey literature databases were searched on 18 January 2021 (PROSPERO: CRD42020168187). Standardised mean difference (SMDpre) effect sizes were used with Bayesian hierarchical meta-analysis models to calculate the 0.25 (small), 0.5 (medium) and 0.75 quantiles (large) and compare pooled means across potential moderators. Risk of bias was assessed with Cochrane...
BMJ Open Sport & Exercise Medicine
PurposeTo assess the effectiveness of surgery on all tendinopathies by comparing it to no treatment, sham surgery and exercise-based therapies for both mid-term (12 months) and long-term (> 12 months) outcomes.MethodsOur literature search included EMBASE, Medline, CINAHL and Scopus. A combined assessment of internal validity, external validity and precision of each eligible study yielded its overall study quality. Results were considered significant if they were based on strong (Level 1) or moderate (Level 2) evidence.Results12 studies were eligible. Participants had the following types of tendinopathy: shoulder in seven studies, lateral elbow in three, patellar in one and Achilles in one. Two studies were of good, four of moderate and six of poor overall quality. Surgery was superior to no treatment or placebo, for the outcomes of pain, function, range of movement (ROM) and treatment success in the short and midterm. Surgery had similar effects to sham surgery on pain, function ...
Sports Medicine - Open
Introduction Exercise therapy is usually prescribed as first-line treatment for lower limb tendinopathies. The multitude of exercise- and non-exercise-based management options can be overwhelming for the treating sports professional and patient alike. We chose to investigate the comparative effectiveness of exercise therapy with or without adjuncts for managing the commonest lower limb tendinopathies. Methods Through an extensive systematic literature search using multiple databases, we aimed to identify eligible randomised controlled trials (RCTs) on Achilles tendinopathy, patellar tendinopathy or greater trochanteric pain syndrome (GTPS) that included at least one exercise intervention in their treatment arms. Our primary outcomes were patient-reported pain and function (Victorian Institute of Sport Assessment; VISA). Follow-up was defined as short-term (≤ 12 weeks), mid-term (> 12 weeks to < 12 months) and long-term (≥ 12 months). The risk of bias and strength of evidence w...
Health Technology Assessment
Background Tendinopathy is a common, painful and functionally limiting condition, primarily managed conservatively using exercise therapy. Review questions (i) What exercise interventions have been reported in the literature for which tendinopathies? (ii) What outcomes have been reported in studies investigating exercise interventions for tendinopathy? (iii) Which exercise interventions are most effective across all tendinopathies? (iv) Does type/location of tendinopathy or other specific covariates affect which are the most effective exercise therapies? (v) How feasible and acceptable are exercise interventions for tendinopathies? Methods A scoping review mapped exercise interventions for tendinopathies and outcomes reported to date (questions i and ii). Thereafter, two contingent systematic review workstreams were conducted. The first investigated a large number of studies and was split into three efficacy reviews that quantified and compared efficacy across different intervention...
Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon
Clinical Orthopaedics and Related Research, 2008
Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options. We performed a systematic review of the literature to determine the best treatment options for tendinopathy. We evaluated the effectiveness of NSAIDS, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, sclerotherapy, nitric oxide patches, surgery, growth factors, and stem cell treatment. NSAIDS and corticosteroids appear to provide pain relief in the short term, but their effectiveness in the long term has not been demonstrated. We identified inconsistent results with shock wave therapy and physical therapy modalities such as ultrasound, iontophoresis and low-level laser therapy. Current data support the use of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, but larger, multicenter trials are needed to confirm the early results with these treatments. Preliminary work with growth factors and stem cells is promising, but further study is required in these fields. Surgery remains the last option due to the morbidity and inconsistent outcomes. The ideal treatment for tendinopathy remains unclear. Level of Evidence: Level II, systematic review. See the Guidelines for Authors for a complete description of levels of evidence.
Low Level Laser Treatment of Tendinopathy: A Systematic Review with Meta-analysis
Photomedicine and Laser Surgery, 2010
Objectives: To assess the clinical effectiveness of Low Level Laser Therapy (LLLT) in the treatment of tendinopathy. Secondary objectives were to determine the relevance of irradiation parameters to outcomes, and the validity of current dosage recommendations for the treatment of tendinopathy. Background: LLLT is proposed as a possible treatment for tendon injuries. However, the clinical effectiveness of this modality remains controversial, with limited agreement on the most efficacious dosage and parameter choices. Method: The following databases were searched from inception to 1 st August 2008: MEDLINE, PubMed, CINAHL, AMED, EMBASE, All EBM reviews, PEDro (Physiotherapy Evidence Database), SCOPUS. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified as: high (!6 out of 10 on the PEDro scale) or low (<6) to grade the strength of evidence. Accuracy and clinical appropriateness of treatment parameters were assessed using established recommendations and guidelines. Results: Twenty-five controlled clinical trials met the inclusion criteria. There were conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies would support the existence of an effective dosage window that closely resembled current recommended guidelines. In two instances where pooling of data was possible, LLLT showed a positive effect size; in studies of lateral epicondylitis that scored !6 on the PEDro scale, participants' grip strength was 9.59 kg higher than that of the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: LLLT can potentially be effective in treating tendinopathy when recommended dosages are used. The 12 positive studies provide strong evidence that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.
Clinical Outcomes of Biologic Treatment for Chronic Tendinopathy
Operative Techniques in Orthopaedics, 2016
Biological interventions, such as ultrasound guided platelet rich plasma (PRP) injections, are a second line treatment worth considering for recalcitrant tendinopathy, but efficacy and effectiveness have not been established yet. The use of PRP has been most commonly studied in lateral epicondylitis, with nine randomized controlled trials and seven prospective controlled studies in the medical literature. Corticosteroid injection was used as the comparator in six studies, autologous blood in three, and local anesthetic agents in two studies. Recent meta-analyses showed that PRP and autologous blood are superior to corticosteroids in pain reduction and ameliorating functionality in epicondylitis. PRP efficacy on supraspinatus tears are controversial, and PRP is better than controls in two out of five studies, when compared with corticosteroids and dry needling. Patellar tendinopathy is examined in four controlled studies, and eight case series, PRP ameliorated outcomes but not in all cases. Whether more than one injection should be given is under discussion. Achilles tendinopathy was examined in three prospective controlled studies (a single injection), and six case series. Patients showed improvements regarding baseline values, but two controlled studies failed to reveal differences with controls. Pooling data across studies is challenging because of heterogeneity in outcome scores and comparators. Tendinopathy progression and outcomes are poorly monitored with self-reported questionnaires that are not sensitive enough to discriminate local changes. Molecular indicators of tendon health and disease can help to assess whether the condition progress or heal after biological interventions. The international consensus about the design of clinical studies should be pursued.